Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993118 DEA: 101C3304 EFIS: 1014000146
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-205-R4.6/R9.0
Work Description: Widening bridges, ramps and roadway. SR205 SMART CORRIDOR - PHASE 2
Location Description: On state highway in San Joaquin County in and near Tracy from Janney Overhead to 1.3 miles east of MacArthur Drive Overcrossing.
Contractor Name: Bay Cities Paving & Grading Inc.
Contractor Address: 1450 Civic Ct., Bldg B #400, Concord, CA 94520
Resident Engineer: Chris Hanson Structure Rep.: Ron Matin
DIME Sample ID: 2023-06-07-104
TL Number from the TL Form: 035603
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 06/07/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/09/2023
The quantity of what the sample constitutes: 2 of 2,
A brief description of the sample: PG 70-10
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina
Performance Grade: PG 70-10
Modified: No
Lot number: 2
Sublot number: 1
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Albina Asphalt - Chowchilla CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
